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Decoders optimized offline to reconstruct intended movements from neural recordings sometimes fail to achieve optimal performance online when they are used in closed-loop as part of an intracortical brain-computer interface (iBCI). This is because typical decoder calibration routines do not model the emergent interactions between the decoder, the user, and the task parameters (e.g. target size). Here, we investigated the feasibility of simulating online performance to better guide decoder parameter selection and design. Three participants in the BrainGate2 pilot clinical trial controlled a computer cursor using a linear velocity decoder under different gain (speed scaling) and temporal smoothing parameters and acquired targets with different radii and distances. We show that a user-specific iBCI feedback control model can predict how performance changes under these different decoder and task parameters in held-out data. We also used the model to optimize a nonlinear speed scaling function for the decoder. When used online with two participants, it increased the dynamic range of decoded speeds and decreased the time taken to acquire targets (compared to an optimized standard decoder). These results suggest that it is feasible to simulate iBCI performance accurately enough to be useful for quantitative decoder optimization and design.

Objectives: Clinical criteria for Traumatic Encephalopathy Syndrome (ccTES) were developed for research purposes to reflect the clinical symptoms of Chronic Traumatic Encephalopathy (CTE). The aims of this study were to 1) determine whether there was an association between the research diagnosis of TES and impaired postural balance among retired professional fighters, and 2) determine repetitive head impacts (RHI) exposure thresholds among both TES positive and TES negative groups in retired professional fighters when evaluating for balance impairment. Methods: This was a pilot study evaluating postural balance among participants of the Professional Athletes Brain Health Study (PABHS). Among the cohort, 57 retired professional fighters met the criteria for inclusion in this study. A generalized linear model with generalized estimating equations was used to compare various balance measures longitudinally between fighters with and without TES. Results: A significant association was observed between a TES diagnosis and worsening performance on double-leg balance assessments when stratifying by RHI exposure thresholds. Additionally, elevated exposure to RHI was significantly associated with increased odds of developing TES; The odds for TES diagnosis were 563% (95% CI = 113, 1963; p-value = 0.0011) greater among athletes with 32 or more professional fights compared to athletes with less than 32 fights when stratifying by balance measures. Likewise, the odds for TES diagnosis were 43% (95% CI = 10, 102; p-value = 0.0439) greater with worsening double leg stance balance in athletes exposed to 32 or more fights. Conclusion: This pilot study provides preliminary evidence of a relationship between declining postural balance and a TES diagnosis among retired professional fighters with elevated RHI exposure. Further research exploring more complex assessments such as the Functional Gait Assessment may be of benefit to improve clinical understanding of the relationship between TES, RHI, and balance. [ABSTRACT FROM AUTHOR]

ObjectiveBrain-computer interfaces (BCIs) can enable individuals with tetraplegia to communicate and control external devices. Though much progress has been made in improving the speed and robustness of neural control provided by intracortical BCIs, little research has been devoted to minimizing the amount of time spent on decoder calibration.ApproachWe investigated the amount of time users needed to calibrate decoders and achieve performance saturation using two markedly different decoding algorithms: the steady-state Kalman filter, and a novel technique using Gaussian process regression (GP-DKF).Main resultsThree people with tetraplegia gained rapid closed-loop neural cursor control and peak, plateaued decoder performance within 3 min of initializing calibration. We also show that a BCI-naïve user (T5) was able to rapidly attain closed-loop neural cursor control with the GP-DKF using self-selected movement imagery on his first-ever day of closed-loop BCI use, acquiring a target 37 s after initiating calibration.SignificanceThese results demonstrate the potential for an intracortical BCI to be used immediately after deployment by people with paralysis, without the need for user learning or extensive system calibration.

Purpose: This research project aims to evaluate the potential effectiveness of a vocational recovery model promoting both vocational and personal recovery for young people with mental illness. Methods: In this study, a one group pre-posttest design was conducted, involving 37 young people with mental illness who received a vocational recovery program that consisted of a psychoeducation group on recovery, social skills and job-related skills training, 3-month job internship, and individual follow-up services. Standardized assessment tools were used for outcomes assessment at baseline, 3 months after treatment began, and 6 months after treatment began. Results: Results indicated that the participants showed improved competitive employment rates, personal recovery, and social support at follow-up assessments. Conclusions: The present study supports the feasibility and effectiveness of a vocational recovery model for young people with mental illness, suggesting the importance of integrating recovery framework and strategies into community-based vocational service.

Purpose: This research study aims to evaluate the effectiveness of a psychoeducation group, which is founded on an Eastern approach to health care, in improving the quality of life of Chinese people with mild cognitive impairment (PwMCI). Method: In a randomized controlled trial (RCT), 40 Chinese PwMCI were randomly assigned to either a 10-session psychoeducation group or the control group. Results: A paired sample t test indicated that the treatment group (n = 18) showed significant improvement in their World Health Organization Quality of Life Measure (WHOQOL) score, while the control group (n = 22) did not. Moreover, an independent t test showed that the treatment group was more effective than the control group to improve their WHOQOL score. A reduction in the depressive symptoms was related to the improvement in WHOQOL score. Conclusions: This RCT provides evidence to support the feasibility and effectiveness of psychoeducation groups for improving the overall quality of life of PwMCI.

Background: Decreasing healthcare disparities in marginalized communities requires healthcare providers who understand and appreciate social, economic, and cultural backgrounds. This includes care and education focused on individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Methods: This study examined dental students' and residents' self‐reported clinical preparedness, prejudicial attitudes (implicit and explicit), and knowledge of health disparities that exist in the LGBTQ community using the Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale (LGBT‐DOCSS) prior to and after the presentation of an LGBTQ competency course. Results: A total of 178 dental students at a private US dental school ranging from D1 to first‐year postdoctoral residency participated in the course and completed both pre‐course survey and post‐course survey. Sixty‐seven percent of the students reported having formal training in LGBTQ competency prior to completing the pre‐training survey. The results of the LGBT‐DOCSS in this population following intervention training revealed an increased feeling of clinical preparedness in treating LGBTQ patients, decreased bias toward LGBTQ, and increased knowledge of health disparities in the LGBTQ community. A more significant percentage of male respondents self‐reported prejudicial beliefs. Knowledge of LGBTQ health issues increased significantly among pre‐clinical students. Conclusion: Introducing an early intervention LGBTQ competency course in the dental curriculum is an effective method of improving students' awareness and self‐confidence in working with LGBTQ patients while decreasing biases that may have existed prior to a training course. [ABSTRACT FROM AUTHOR]

This research project aims to evaluate the effectiveness of a cognitive behavioral therapeutic (CBT) group in reducing self-stigma for people with mental illness in Chinese society. In this study, a quasi-experimental research method was adopted involving 71 people with mental illness receiving community-based mental health services. In total, 33 treatment group participants were assigned to a 10-session CBT group, while 38 control group participants received treatment as usual. Standardized assessment tools were used to collect data in the pre- and posttreatment periods by a research assistant. Analysis of covariance demonstrated that the CBT group was significantly more effective than the control group in terms of reducing self-stigma and depressive mood, with a moderate effect size, even after controlling for differences in various demographic variables between the treatment and control groups. This study provides evidence to support the efficacy and effectiveness of a CBT group for reducing self-stigma for people with mental illness.

Background: Burnout is a condition characterized by emotional exhaustion, low personal accomplishment, and feelings of depersonalization that may evolve as a result of chronic occupational stress. Our goal for the study was to measure the degree of burnout among US dental school faculty with less than 10 years in academia. Materials and methods: A mixed method approach to data collection was utilized for the study and included: A. A 15‐items demographics survey B. Maslach Burnout Inventory (MBI) combined with the Area‐Work life Scale (AWS) C. A survey open‐ended response to respondent's general feelings about work environment. Results: MBI results from the data collected from 52 respondents indicate 7 or 13.46% of respondents are categorized with a 'burnout' profile. The most abundant categories recognized among this group are feelings of being "overextended" (34.62%) while 32.69% of the respondents self‐report signs of being engaged. The results from this population indicate higher emotional exhaustion while levels of depersonalization are lower. The Area‐Work life Scale (AWS) for this group indicates a higher sense of reward and control, while a lower frequency of workload balance and fairness are recognized. The data collected from the sample population suggest increased higher feelings of burnout at the 9‐year mark, with increased administrative duties, and age range over 44 years. Conclusion: Identifying factors in workload, work environment, and influences in the home that lead to burnout early in a faculty member's tenure and introducing reduction mechanisms are key to enhancing faculty production, satisfaction, and retention. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to translate and test the reliability and validity of the Internalized Stigma of Mental Illness-Cantonese (ISMI-C). Methods: The original English version of ISMI is translated into the ISMI-C by going through forward and backward translation procedure. A cross-sectional research design is adopted that involved 295 participants randomly drawn from a population of Chinese consumers participated in different kinds of community-based mental health services. Results: Results show that the Cronbach's a coefficient of the ISMI-C is 0.93. With regard to validity test, the ISMI-C shows significant and negative correlation with measures on self-esteem and quality of life. Also, an explorative factor analysis yields five factors that are consistent with previous research results. Discussion: This study shows that the ISMI-C is a reliable and valid measure. ISMI-C can facilitate the development of interventions in reducing self-stigma for people with mental illness across Chinese societies.

Objective: This study examined the effectiveness of group cognitive behavioral intervention (CBI) in improving mental health and promoting postmigration growth for Mainland university students in Hong Kong. Methods: Thirty-six Mainland students with mild-to-moderate levels of psychological distress have completed an 8-session CBI group. Various mental health measures have been administered at the pre-, post-, and 3-month follow-up tests. Results: The levels of psychological distress, acculturative stress, and negative emotions and negative thoughts of the participants were significantly reduced, while their positive emotions and postmigration growth were significantly increased upon completion of the CBI group. The positive effects were maintained at 3-month follow-up. Conclusions: CBI group appears to be an effective intervention approach for improving the mental health and promoting postmigration growth for Mainland university students in Hong Kong. Implications for social work practices when engaging with Chinese international students were provided.

The resources framework provides a useful and generative model of student thinking and learning. In particular, it suggests various strategies for instruction such as priming resources and refining intuition that allow students to build on knowledge they already have. In this paper, we describe the affordances of the resources framework in guiding the design, assessment, and refinement of interventions on pressure in fluids. This perspective kept us alert for cognitive resources on which students could build a deeper understanding and encouraged us to model student thinking as complex and context dependent, even on this narrow topic. This framework also facilitated a focus on evidence of productivity in student work as an alternative assessment to conceptual pre- and post testing.

Abstract Spinal epidural lipomatosis is a rare complication of chronic corticosteroid treatment. We report a new pediatric case and an analysis of this and 19 pediatric cases identified in the international literature. The youngest of these combined 20 patients was 5 years old when lipomatosis was diagnosed. Lipomatosis manifested after a mean of 1.3 (+/- 1.5) years (SD) (median, 0.8 years; range, 3 weeks - 6.5 years) of corticosteroid treatment. The corticosteroid dose at the time of presentation of the lipomatosis ranged widely, between 5 and 80 mg of prednisone/day. Back pain was the most common presenting symptom. Imaging revealed that lipomatosis almost always involved the thoracic spine, extending into the lumbosacral region in a subset of patients. Predominantly lumbosacral involvement was documented in only two cases. Although a neurological deficit at presentation was documented in about half of the cases, surgical decompression was not performed in the cases reported after 1996. Instead, reducing the corticosteroid dose (sometimes combined with dietary restriction to mobilize fat) sufficed to induce remission. In summary, pediatric spinal epidural lipomatosis remains a potentially serious untoward effect of corticosteroid treatment, which, if recognized in a timely manner, can have a good outcome with conservative treatment.

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To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services. Retrospective cohort analysis of admissions from December 2016 to September 2019 Medicine, neurology, and surgery units (n=47) at a tertiary hospital. We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients). Not applicable. We examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit. Patient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or "6 clicks") inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting). Using an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults. Nursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs. [ABSTRACT FROM AUTHOR]

Importance: Assessing patients' activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes. Objective: To investigate the association between patients' ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition. Design: Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission. Setting: Two inpatient units at the Johns Hopkins Hospital. Participants: Hospitalized patients with various diagnoses, including neurosurgical, stroke, and general neurology (N = 1,899). Results: People with lower AM-PAC scores (every 10-point difference) had increased odds (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.4–1.8) of being in the highest length-of-stay quartile (≥8 days), having an injurious fall (OR = 1.7; 95% CI = 1.3–2.2), acquiring a pressure injury (OR = 2.7; 95% CI = 1.5–5.3), and being discharged to a postacute care facility (OR = 3.02; 95% CI = 2.1–2.7). Conclusions and Relevance: Greater functional impairments in ADLs, measured with the AM-PACS IASF, were significantly associated with worse outcomes. AM-PAC IASF scores may be useful in identifying patients with ADL deficits and targeting occupational therapy services for patients who are at higher risk for negative outcomes. What This Article Adds: Early assessment of ADL function in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes. This study found that early assessment of activities of daily living (ADLs) in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization. Problem: While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published. Approach: JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness. Conclusions: Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions. [ABSTRACT FROM AUTHOR]